Assessment of carotid intima-media thickness in subjects with ischemic cerebrovascular events undergoing endarterectomy

Background and aim: In clinical settings, the degree of lumen stenosis is the parameter used to select patients for carotid surgery. The present study was designed to measure carotid intima-media thickness (IMT), an indicator of atherosclerotic burden, in a sample of consecutive patients with ischemic cerebrovascular events referred for endarterectomy. Methods and results: Carotid endarterectomy specimens from 55 consecutive patients (age 66 10 years) admitted to hospital with recent documented atherothrombotic ischemic cerebrovascular events were compared with 24 carotid arteries from people (age 68 11 years) who had died from documented causes unrelated to cerebrovascular disease. Measurement of extracranial carotid atherosclerosis was made from three anatomically defined segments, using image-processing software. A total of 426 cross sections was analyzed. Increasing IMT measures were clearly associated with increased risk of an ischemic event. Single maximum IMT values of 2.33 mm (95% CI, 1.69-2.96) for the common carotid, 2.45 mm (95% CI, 1.97-2.93) for the bifurcation, and 2.23 (95% CI, 1.83-2.64) for the internal carotid were associated with a 75% probability of a cerebrovascular ischemic accident. Receiver operator characteristic curve analyses demonstrated that the diagnostic ability of IMT measurements performed at the level of internal carotid artery to separate cases from controls was greater than common carotid artery or bifurcation measurements. Conclusions: The present pathology study provides data on IMT in patients admitted to hospital for cerebrovascular accidents and referred for carotid endarterectomy. (c) 2005 Elsevier B.V. All rights reserved.